Evaluation of the serrated lesions detection rate and its role as a colonoscopy quality criteria

Objectives: To evaluate the serrated lesion detection rate in colonoscopy at a specialized clinic and its role as quality criteria for endoscopic examination. Methods: This is an observational cross-sectional study with all patients that underwent colonoscopy between October 2018 and May 2019, performed by an experimented physician. A questionnaire was answered before the examination by the patient, and another questionnaire after the colonoscopy was answered by themedical team. All polyps identified were removed and sent to the same pathologist for analysis. Results: A total of 1,000 colonoscopies were evaluated. The average age of the patients was 58.9 years old, and most of them were female (60.6%). In 62.5% of the procedures, polyps were removed, obtaining a total of 1,730 polyps, of which 529 were serrated lesions, being 272 sessile serrated lesions (SSL). This data resulted in a serrated lesion detection rate (SDR) of 29.2%, and of 14% when considering only the SSL detection rate (SSLDR). The right colon had higher rates, with 22.3% SDR and 15.3% SSLDR. Screening colonoscopies also presented a higher serrated detection rate, of 20%, followed by diagnostics and follow-up exams. Smoking was the only risk factor associated with higher serrated detection rate. Conclusions: The serrated lesion detection rate is higher than the ones already previously suggested and the have the higher rates were stablished in the right colon and on screening exams. (AU)

Helicobacter pylori and colorectal neoplasms: a concise review / Helicobacter pylori e neoplasias colorretais: revisão concisa

ABSTRACT Helicobacter pylori is the main etiological agent of all malignant tumors caused by an infectious disease. It is a major, at times dominant, factor in the pathogenesis of a large spectrum of diseases such as acute and chronic gastritis, gastric and duodenal ulcers, gastric carcinoma, and lymphoma. Epidemiological and experimental studies suggest that H. pylori chronic infection may be related to different extragastric diseases, including colorectal neoplasms. This concise review aims to explore the association of H. pylori infection with colorectal cancer and adenoma, including the recent epidemiological findings, the diagnostic methods employed to detect H. pylori and virulent factors, and the potentially involved mechanisms. Furthermore, is attempted to establish the current data integration for causal inference using the Bradford-Hill causality criteria. The weak, although global, strength of the epidemiological positive association between H. pylori infection and colonic neoplasms associated to new mechanisms postulated to explain this interaction, including intestinal dysbiosis, should stimulate future studies. Prospective confirmatory studies to establish the role of H. pylori eradication in the process of carcinogenic transformation of the colonic epithelium may define its eventual role in the treatment and prevention of colonic neoplasms.

RESUMO Helicobacter pylori é o principal agente etiológico dos tumores malignos causados por doenças infecciosas. Constitui fator importante, às vezes dominante, na patogênese de um amplo espectro de doenças como gastrite aguda e crônica, úlceras gástricas e duodenais, carcinoma gástrico e linfoma. Estudos epidemiológicos e experimentais sugerem que a infecção crônica por H. pylori pode estar relacionada a diferentes doenças extragástricas, incluindo neoplasias colorretais. Esta concisa revisão tem como objetivo explorar a associação da infecção por H. pylori com câncer colorretal e adenoma, incluindo os recentes achados epidemiológicos, os métodos de diagnóstico empregados para detectar H. pylori e seus fatores de virulência com os mecanismos potencialmente envolvidos nesta relação. Além disso, procura-se estabelecer a integração dos dados atuais na busca de inferência causal com o emprego dos critérios de causalidade de Bradford-Hill. A associação epidemiológica positiva entre infecção por H. pylori e neoplasias do cólon embora classificada como fraca - porém global - do ponto de vista epidemiológico, quando associada a mecanismos recentemente postulados para explicar essa interação, incluindo disbiose intestinal, deverá estimular a realização de investigações futuras. Estudos prospectivos confirmatórios para estabelecer o papel da erradicação do H. pylori no processo de transformação carcinogênica do epitélio do cólon são aguardados para definir seu eventual papel no tratamento e prevenção de neoplasias do cólon.

Medicina de precisión: aspectos prácticos para el cirujano moderno / Precision medicine: practical aspects for the modern surgeon

Los contenidos de este capítulo se basan en la 3a edición de las Clínicas Quirúrgicas de Cáncer Colorrectal. C. Vaccaro y N. Peralta. del hospital ediciones 2020 (en prensa)

A clinical study of newly-diagnosed colorectal cancer over 2 years in a gastroenterology center in Iraq / Estudo clínico de câncer colorretal recém-diagnosticado por 2 anos em um centro de gastroenterologia no Iraque

ABSTRACT Background and study aims: Colorectal cancer (CRC) is the most common gastrointestinal cancer and the third most commonly diagnosed malignancy affecting about one million individuals each year. The etiology for most cases of CRC appears to be related to environmental factors. This study to describe the main characteristics of this malignancy regarding age, gender, and anatomical sub site distribution, as well as the main presenting symptoms in Iraqi patients. Patients and methods: Patients with newly-diagnosed CRC by colonoscopy findings and confirmed by histopathological examination of endoscopic colonic biopsies were studied. Results: Sixty three cases with a newly-diagnosed CRC were included in this study. There were 31 (49.2%) males and 32 (50.8%) females. CRC peaked in the 60-69 years old age group (p < 0.05), more than 60% were between 40 and 69 years old. Fresh bleeding per rectum was the most common symptom occurred in 48 (76.2%) patients; while the least common was weight loss (19%). The mean duration of symptoms before referral was 7.3 ± 12.6 months. The tumor sites of the CRC were the rectum and sigmoid region seen in 77.8% (p < 0.05), the rectum alone reported in 37 patients (58.7%); followed by sigmoid colon in 12 (19%) patients, cecum in 7 (11.1%) patients and the ascending colon seen in 2 (3.2%) patients. Conclusions: In this study CRC occurs in relatively younger age groups in comparison to studies in the developed countries with rectal cancer predominates of all colorectal cancers.

RESUMO Contexto e objetivos do estudo: O câncer colorretal é a neoplasia gastrointestinal mais comum e o terceiro tumor maligno mais comumente diagnosticado, afetando cerca de um milhão de pessoas anualmente. A etiologia da maioria dos casos de câncer colorretal parece estar relacionada a fatores ambientais. Este estudo descreve as principais características dessa neoplasia quanto à idade, gênero e distribuição anatômica do subsite, bem como os principais sintomas observados em pacientes iraquianos. Pacientes e métodos: O estudo avaliou pacientes com câncer colorretal recém-diagnosticado por achados de colonoscopia e confirmados por exame histopatológico de biópsias endoscópicas do cólon. Resultados: O estudo incluiu 63 casos de pacientes com câncer colorretal recém-diagnosticado; 31 (49,2%) homens e 32 (50,8%) mulheres. O câncer colorretal atingiu o pico na faixa etária de 60 a 69 anos (p < 0,05); mais de 60% dos pacientes tinham entre 40 e 69 anos de idade. O sangramento retal fresco foi o sintoma mais comum em 48 (76,2%) pacientes; o sintoma menos comum foi a perda de peso (19%). A duração média dos sintomas antes do encaminhamento para especialista foi de 7,3 ± 12,6 meses. Os principais sítios tumorais do câncer colorretal foram a região do reto e sigmoide em 77,8% dos pacientes (p < 0,05) e o reto isolado em 37 pacientes (58,7%); seguido por cólon sigmoide em 12 pacientes (19%), ceco em sete (11,1%) e cólon ascendente em dois pacientes (3,2%). Conclusões: No presente estudo, o câncer colorretal foi observado em grupos etários relativamente mais jovens do que em estudos conduzidos em países desenvolvidos; a neoplasia retal foi o tipo de câncer colorretal mais comumente observado.

Fatores ambientais e conscientização sobre o câncer colorretal em pessoas com risco familiar / Environmental factors and awareness of colorectal cancer in people at familial risk / Factores ambientales y conciencia sobre el cáncer colorrectal en personas con riesgo familiar

Objetivo identificar a associação entre os fatores de risco ambientais e a conscientização sobre o câncer colorretal em pessoas com risco familiar. Método estudo correlacional de corte transversal, cuja amostra foi constituída por pessoas que cumpriam pelo menos um dos critérios de Bethesda Revisados, sendo 80 participantes incluídos no estudo. Foram utilizados uma ficha com dados sociodemográficos, o Teste AUDIT para o consumo de álcool, o Teste de Fagerström para o tabagismo, a escala de Estimativa e Consumo de Alimentos, e o questionário Cancer Awareness Measure para avaliar a conscientização sobre o câncer colorretal. O índice de massa corporal foi calculado, e estatísticas descritivas e o Coeficiente de Correlação de Pearson foram usados para estimar a associação. Resultados o sexo feminino foi o mais prevalente, com média de idade de 37,8 anos, quase metade dos participantes apresentava sobrepeso, 45% apresentavam sintomas de dependência de álcool, metade da amostra teve o fator hereditário relacionado com o desenvolvimento de câncer colorretal, e menos da metade conhecia programas preventivos deste câncer. Conclusão há pouca informação sobre os principais fatores de risco ambientais, sinais e sintomas do câncer colorretal, e nenhuma associação significativa foi encontrada entre eles e conscientização sobre o câncer colorretal.

Objective to identify the association between environmental risk factors and awareness of colorectal cancer in people at familial risk. Method cross-sectional correlational study, with a sample consisted of people who met at least one of the Revised Bethesda criteria, and 80 participants were included in this study. A sociodemographic data record, the AUDIT Test for alcohol use, the Fagerström Test for tobacco smoking, the Estimation and Frequency of Food Intake scale, and the Cancer Awareness Measure questionnaire to assess the colorectal cancer awareness were used. Body mass index was calculated, and descriptive statistics and the Pearson's Correlation Coefficient were used to estimate the association. Results female sex predominated, with an average age of 37.8 years, almost half of the participants were overweight, 45% showed symptoms of alcohol dependence, half of the sample showed an association between hereditary factors and the development of colorectal cancer, and less than half of them were aware of cancer prevention programs. Conclusion there is little information on the main environmental risk factors, signs and symptoms of colorectal cancer, and no significant association was found between these and colorectal cancer awareness.

Objetivo identificar la asociación entre factores de riesgo ambientales y la conciencia sobre el cáncer colorrectal en personas con riesgo familiar. Método estudio transversal correlacional; la muestra estuvo constituida por personas que cumplieran al menos uno de los criterios de Bethesda Revisados; se incluyeron 80 participantes en el estudio; se empleó una cédula de datos sociodemográficos, el Test AUDIT para el consumo de alcohol, Test de Fagerström para el consumo de tabaco, escala Estimación y Consumo de Alimento y el cuestionario Cancer Awareness Measure para la conciencia sobre el cáncer colorrectal, además se calculó el índice de masa corporal; se obtuvo estadística descriptiva y el Coeficiente de Correlación de Pearson para la asociación. Resultados predominó el sexo femenino, con una media de edad de 37,8 años; casi la mitad de los participantes presentó sobrepeso, un 45% mostró síntomas de dependencia al alcohol, la mitad de la muestra relaciona el factor hereditario con el desarrollo de cáncer colorrectal y menos de la mitad conoce programas preventivos sobre el mismo. Conclusión existe poca información sobre los principales factores de riesgo ambientales, signos y síntomas del cáncer colorrectal; no se encontró una asociación significativa entre estos y la conciencia sobre el cáncer colorrectal.

Relación entre la disponibilidad alimentaria y la mortalidad por cáncer colorrectal en América / Association between food availability and mortality due to colorectal cancer in the Americas

RESUMEN Con el objetivo de describir la relación entre la disponibilidad alimentaria y la tasa de mortalidad por cáncer colorrectal en los países de América en el año 2010, se analizaron datos provistos por la International Agency for Research on Cancer y la Food and Agriculture Organization mediante un estudio ecológico. Se observó una gran variabilidad excepto en disponibilidad calórica. La disponibilidad alimentaria fue abundante para calorías, grasas totales, grasa animal, carnes rojas y bebidas alcohólicas. Para frutas y vegetales fue crítica en un 80% de los países. Los países con más alta tasa de mortalidad por cáncer colorrectal fueron Uruguay, Barbados, Argentina y Cuba, y con las tasas más bajas fueron Guatemala, Canadá, México y Honduras. Las relaciones más fuertes se dieron entre la tasa de mortalidad por cáncer colorrectal y la disponibilidad alimentaria de grasa animal, carne roja, bebidas alcohólicas y calorías. No se encontró efecto protector de la disponibilidad alimentaria de frutas y vegetales sobre la tasa de mortalidad por cáncer colorrectal. Sería recomendable mejorar los registros de incidencia de tumores y de formas directas de evaluar la dieta para ser analizados en futuros estudios en lugar de los datos aquí utilizados.

ABSTRACT With the aim of describing the association between food availability and the mortality rate due to colorectal cancer in the countries of the Americas in 2010, data provided by the International Agency for Research on Cancer and the Food and Agriculture Federation were analyzed in an ecological study. Great variability was observed except in caloric supply. Food availability was abundant for calories, total fats, animal fat, red meat and alcoholic beverages. Availability was critically low for fruits and vegetables in 80% of the countries. The countries with the highest colorectal cancer mortality rates were Uruguay, Barbados, Argentina and Cuba, while those with the lowest rates were Guatemala, Canada, Mexico and Honduras. The strongest relationships were found between colorectal cancer mortality rate and the availability of animal fat, red meat, alcoholic beverages and calories. No protective effect of availability of fruits and vegetables on the colorectal cancer mortality rate was found. It would be advisable to improve the records of tumor incidence and direct ways of evaluating diet to be analyzed in future studies instead of the data used here.

Population attributable fractions for colorectal cancer and red and processed meats in Colombia - a macro-simulation study / Fracción Atribuible Poblacional de carnes rojas y procesadas en cáncer colorrectal en Colombia - un estudio de macro-simulación

Abstract: Aim: to estimate the population attributable risk of consumption of red and processed meat for colorectal cancer in Colombia. Methods: to model the expected incidence of colorectal cancer in the hypothetical situation of no red and processed meat consumption in Colombia, for the year 2010. A dynamic macrosimulation model, PREVENT 3.01, was used to integrate available cancer incidence, meat consumption prevalence and associated risk data and to evaluate the impact of eliminating red and processed meat from the Colombian diet on national colorectal cancer incidence. Results: Eliminating consumption of red meat altogether from the Colombian diet resulted in reductions in age-standardized colorectal cancer incidence, translating in reductions of 331 males (PAF 13%) and 297 female cases (PAF 10%). Eliminating processed meats had slightly stronger effects, with decreases of 362 males (PAF 14%) and 388 female cases (PAF 13%). Conclusions: A substantial proportion of the burden of colorectal cancer in Colombia can be attributed to the consumption of red and processed meat.

Resumen: Objetivo: estimar la fracción atribuible poblacional de consumo de carne roja y procesada para el cáncer colorrectal en Colombia. Métodos: modelación de la incidencia esperada de cáncer colorrectal en la situación hipotética de no consumo de carne roja y procesada en Colombia para el año 2010. Se utilizó un modelo dinámico de macrosimulación, PREVENT 3.01, para integrar los datos disponibles sobre incidencia de cáncer y evaluar el impacto de la eliminación de la dieta colombiana de la carne roja y procesada sobre la incidencia nacional de cáncer colorrectal. Resultados: La eliminación del consumo total de carne roja de la dieta colombiana dio lugar a reducciones en la incidencia estandarizada por edad de cáncer colorrectal, traduciéndose en la disminución de 331 casos en hombres (FAP 13%) y 297 en mujeres (FAP 10%). La eliminación de carnes procesadas tuvo efectos ligeramente más fuertes, con disminución de 362 casos en hombres (FAP 14%) y 388 en mujeres (FAP 13%). Conclusiones: Una proporción sustancial de la carga de cáncer colorrectal en Colombia puede atribuirse al consumo de carne roja y procesada.

Fusobacterium nucleatum. ¿un patógeno periodontal promotor de carcinogénesis colorrectal? / Fusobacterium nucleatum. is this periodontal pathogen a promoter of colorectal carcinogenesis?

El Fusobacterium nucleatum es una bacteria anaerobia Gram negativa,es un residente común en el biofi lm oral y se ha encontrado una estrechaasociación entre las fusobacterias y las periodontitis. El Fusobacteriumnucleatum se ha asociado con el cáncer colorrectal, pero la causalidad y el mecanismo subyacente aún no se han establecido. La microbiota intestinal humana tiene un papel reconocido en el cáncer colorrectal. Se ha encontrado que el Fn se adhiere, invade, e induce respuestas inflamatorias oncogénicas que estimulan el crecimiento de las células de cáncer colorrectal a través de un factor de la adhesina FadA.

The anaerobic, Gram-negative bacterial species Fusobacterium nucleatumis common in oral biofi lm and the association between it andperiodontitis is well-established. Fusobacterium nucleatum has beenassociated with colorectal cancer, though causality and the underlyingmechanism have yet to be determined. The role of the human gutmicrobiota in colorectal cancer has been acknowledged. Fusobacteriumnucleatum has been found to adhere to, invade, and induce oncogenicand infl ammatory responses that stimulate the growth of colorectalcancer cells through its unique FadA adhesin.

Diabetes Mellitus and Site-specific Colorectal Cancer Risk in Korea: A Case-control Study / 예방의학회지

OBJECTIVES: Previous large-scale cohort studies conducted in Korea have found a positive association between diabetes mellitus (DM) and colorectal cancer (CRC) in men only, in contrast to studies of other populations that have found significant associations in both men and women. METHODS: A total of 1070 CRC cases and 2775 controls were recruited from the National Cancer Center, Korea between August 2010 and June 2013. Self-reported DM history and the duration of DM were compared between cases and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by binary and polytomous logistic regression models. RESULTS: DM was associated with an elevated risk of CRC in both men (OR, 1.47; 95% CI, 1.13 to 1.90) and women (OR, 1.92; 95% CI, 1.24 to 2.98). This association remained when we controlled for age, body mass index, alcohol consumption, and physical activity level. In sub-site analyses, DM was associated with distal colon cancer risk in both men (multivariate OR, 2.04; 95% CI, 1.39 to 3.00) and women (multivariate ORs, 1.99; 95% CI, 1.05 to 3.79), while DM was only associated with rectal cancer risk in women (multivariate OR, 2.05; 95% CI, 1.10 to 3.82). No significant association was found between DM and proximal colon cancer risk in either men (multivariate OR, 1.45; 95% CI, 0.88 to 2.41) or women (multivariate OR, 1.79; 95% CI, 0.78 to 4.08). CONCLUSIONS: Overall, DM was associated with an increased risk of CRC in Koreans. However, potential over-estimation of the ORs should be considered due to potential biases from the case-control design.

Desarrollo de neoplasia en pacientes con enfermedad inflamatoria intestinal / Development of malignant tumors in patients with inflammatory bowel disease

Background: The chronic inflammation of the intestinal mucosa, the extra-intestinal manifestations of the disease and the immunosuppressive treatment of inflammatory bowel disease may increase cancer risk. Aim: To report the demographic and clinical features of patients with IBD who developed a malignant tumor. Material and Methods: Retrospective analysis of an IBD patient registry of a private clinic, diagnosed between 1976 and 2014. Results: 437 subjects were included, aged 15-88 years (58% women). Seventy two percent of patients had ulcerative colitis. The median time of follow up was 6 years. Ten patients (2.3%) developed a malignant tumor. In four, the tumor could be related to IBD (two colorectal cancers, one cholangiocarcinoma and one chronic myeloid leukemia (CML)). Two of 45 patients treated with biological therapy developed a tumor (CML and hypernephroma). Three of 170 patients on immunosuppressive treatment developed tumors. Only one had a tumor possibly related with the use of azathioprine (non-melanoma skin cancer). In only two patients, the treatment was changed at the time of their cancer diagnosis, from immunosuppressive medications to mesalamine. Conclusions: Only a small proportion of these patients with IBD developed a malignant tumor. The treatment of IBD has to be determined by the severity of the disease and not by the fear of developing a neoplasia. Following recommendations is fundamental to decrease the possibility of developing this complication.

Comparação entre duas técnicas de genotipagem do HPV em mulheres com lesão intra-epitelial de alto grau / Comparison of two techniques for HPV genotyping in women with high-grade squamous intraepithelial lesion

OBJETIVO: Comparar o desempenho de duas técnicas de genotipagem de papilomavírus humano (HPV), Linear Array e PapilloCheck, em mulheres com lesão intra-epitelial de alto grau (LIAG). MÉTODOS: Foram selecionadas 88 mulheres com diagnóstico citopatológico de LIAG em 2 centros de referência em patologia cervical em Salvador, Bahia, no período de julho de 2006 a janeiro de 2009. Após o diagnóstico citopatológico de LIAG, foram realizadas a coleta de células do colo uterino para a genotipagem do HPV e a biópsia sob visão colposcópica para análise histopatológica do fragmento retirado. Posteriormente à confirmação de NIC2+ pelo exame histopatológico, foi realizada a genotipagem do HPV em 41 mulheres pelas técnicas Linear Array e PapilloCheck. RESULTADOS: Os dois testes apresentaram taxa de concordância geral para detecção do vírus HPV de 97,2% (35/36). Das 36 amostras válidas, 35 (97,2%) foram consideradas positivas em ambos os testes e apenas uma amostra (2,8%) foi considerada discordante. Os genótipos do HPV mais prevalentes detectados através da técnica do Linear Array foram: HPV 16, HPV 56, HPV 35, HPV 45 e HPV 70; e pela técnica PapilloCheck foram: HPV 16, HPV 56, HPV 11, HPV 35 e HPV 42. Foi observado índice semelhante de infecção por múltiplos tipos do HPV nos dois testes analisados (72,5% no Linear Array e 75,0% no PapilloCheck). CONCLUSÕES: Os testes de genotipagem Linear Array e PapilloCheck apresentaram um desempenho equivalente na detecção dos tipos de HPV oncogênicos em mulheres com LIAG, tendo o PapilloCheck a vantagem de ser um método que evita a subjetividade da leitura dos genótipos de HPV. .

PURPOSE: The aim of this study was to compare the performance of two human papillomavirus (HPV) genotyping techniques, Linear Array and PapilloCheck, in women with high-grade squamous intraepithelial lesion (HSIL). METHODS: A total of 88 women with cytological diagnosis of HSIL were recruited at 2 reference centers in cervical pathology in Salvador, Bahia, Brazil, from July 2006 to January 2009. After the cytological diagnosis of HSIL, cervix cells were collected to determine the HPV genotype and a biopsy was obtained under colposcopic vision for histopathological analysis. After the confirmation of CIN2+ by histopathology, HPV genotyping was performed on 41 women by the Linear Array and PapilloCheck methods. RESULTS: Both tests showed an overall concordance rate for HPV detection of 97.2% (35/36). Of the 36 valid samples, 35 (97.2%) were positive in both tests and 1 (2.8%) was discordant, with the Linear Array indicating the presence of multiple types. The most prevalent HPV genotypes detected by the Linear Array technique were HPV 16, HPV 56, HPV 35, HPV 45, and HPV 70; and those detected by the PapilloCheck technique were HPV 16, HPV 56, HPV 11, HPV 35, and HPV 42. A similar rate of infection with multiple HPV types was observed with the two tests (72.5% with the Linear Array and 75.0% with the PapilloCheck). CONCLUSIONS: Linear Array genotyping assay and PapilloCheck showed equivalent performance for the detection of oncogenic HPV types in women with HSIL, with PapilloCheck having the advantage of being a method that avoids subjectivity when reading the HPV genotypes. .

Dendritic cell vaccine treatment of advanced de novo colorectal cancer in renal transplant patients.

Objective: The clinical outcome, especial the immunologic responses to cancer and graft, of dendritic cell (DC) vaccine in the treatment of advanced de novo colorectal cancer (CRC) in renal transplant patients was investigated in this study. Materials and Methods: 7 patients were received 1 cycle tumor lysate pulsed autologous DC vaccine. The positive cell-mediated cytotoxicity responses to DC vaccine against CRC cell in two out of 7 patients were seen by delayed type hypersensitivity (DTH) test. The positive cell-mediated cytotoxicity responses to DC vaccine against normal kidney cell in all 7 patients were not seen by DTH tests and no notable change of renal function during and after vaccination. Conclusions: DC vaccine has emerged as a promising new strategy in the treatment of advanced de novo CRC in renal transplant patients and DC vaccines have become an attractive therapeutic option, developing immune responses specific against CRC cell, achieving clinical efficacy without graft failure.

Intestinal and xxtraintestinal neoplasia in patents with inflammatory bowel diisease in a tertiary care hospital

Context The development of neoplasia is an important concern associated with inflammatory bowel disease (IBD), especially colorectal cancer (CRC). Objectives Our aim was to determine the incidence of intestinal and extraintestinal neoplasias among patients with inflammatory bowel disease. Methods There were retrieved information from 1607 patients regarding demographics, disease duration and extent, temporal relationship between IBD diagnosis and neoplasia, clinical outcomes and risk factors for neoplasia. Results Crohn's disease (CD) was more frequent among women (P = 0.0018). The incidence of neoplasia was higher in ulcerative colitis (UC) when compared to CD (P = 0.0003). Eight (0.99%) patients developed neoplasia among 804 with CD: 4 colorectal cancer, 2 lymphomas, 1 appendix carcinoid and 1 breast cancer. Thirty (3.7%) patients developed neoplasia among the 803 UC: 13 CRC, 2 lymphomas and 15 extraintestinal tumors. While CRC incidence was not different among UC and CD (1.7% vs 0.5%; P = 0.2953), the incidence of extraintestinal neoplasias was higher among UC (2.1% vs 0.5%, P = 0.0009). Ten (26.3%) patients out of 38 with neoplasia died. Conclusions CRC incidence was low and similar in both diseases. There was a higher incidence of extraintestinal neoplasia in UC when compared to CD. Neoplasias in IBD developed at a younger age than expected for the general population. Mortality associated with malignancy is significant, affecting 1/4 of the patients with neoplasia. .

Contexto O desenvolvimento de neoplasias se constitui em preocupação constante em pacientes com doenças inflamatórias intestinais (DII), especialmente o câncer colorretal (CCR). Objetivos Determinar a incidência de neoplasias intestinais e extra-intestinais entre pacientes com DII. Métodos Foram obtidas informações de 1607 pacientes, quanto a dados demográficos, duração e extensão da doença, relação temporal entre diagnóstico das DII e neoplasia, evolução clínica e fatores de risco para neoplasia. Resultados Doença de Crohn (DC) foi mais frequente entre as mulheres (P = 0.0018). A incidência de neoplasia foi maior nos doentes com retocolite ulcerativa (RCU) em relação aos com DC (P = 0.0003). Oito (0.99%) pacientes desenvolveram neoplasia entre 804 com DC: quatro tumores colorretais, dois linfomas, um carcinóide de apêndice e um câncer de mama. Trinta (3.7%) pacientes desenvolveram neoplasia entre os 803 RCU: 13 CCR, 2 linfomas e 15 tumores extra-intestinais. Enquanto a incidência de CCR não diferiu entre RCU e DC (1.7% vs 0.5%; P = 0.2953), a incidência de neoplasias extraintestinais foi maior na RCU (2.1% vs 0.5%, P = 0.0009). Dez (26.3%) pacientes de um total de 38 com neoplasia, evoluíram a óbito durante o seguimento. Conclusões A incidência de CCR foi baixa e similar em ambas as doenças inflamatórias. Observou-se incidência maior de neoplasia extra-intestinal na RCU quando comparada à DC. Neoplasias em doenças inflamatórias se desenvolveram em idade mais precoce do que a esperada para a população geral. A mortalidade associada a neoplasias é significativa, afetando 1/4 dos pacientes. .

Interacciones entre la microbiota y el cáncercolorrectal / Interactions between microbiota and colorectal cancer

El intestino humano alberga un ecosistema complejo constituido por más de 500 especies bacterianas distintas, con determinadas características genéticas y metabólicas, generalmente denominado microbiota. La composición cuantitativa y cualitativa de la flora intestinal y su interacción con la mucosa intestinal se ha asociado en forma variable con condiciones fisiológicas y patológicas. En este contexto, las relaciones entre la microbiota y el cáncer de colon son controvertidas. Se analizarán y discutirán los principales temas en este campo de investigación, los posibles problemas y las perspectivas futuras. Se propone un modelo hipotético en el que el equilibrio de la microflora del hospedero representa un factor importante para el control de los trastornos proliferativos de la mucosa colónica, sobre la base de datos recientemente publicados. El estudio del papel de la microbiota en la aparición del cáncer de colon puede representar un enfoque novedoso y fascinante de esta neoplasia maligna frecuente y compleja.

Poliposis serrata (antiguamente denominada poliposis hiperplásica). Presentación de un caso y revisión de la literatura / Serrated polyposis (previously named hyperplastic polyposis): case report and literature review

Antecedentes: la poliposis hiperplásica es una enfermedad esporádica, con bases genéticas poco conocidas, que se manifiesta usualmente alrededor de los 50 años de edad. Posee un riesgo aumentado para el cáncer colorrectal, el cual ha sido citado de hasta un 50 % en diferentes series de la literatura. En su patogénesis ha sido implicada la secuencia pólipo hiperplásico-adenoma serrato-cáncer colorrectal. Objetivo: presentar un caso clínico y realizar una revisión bibliográfica del tema, especialmente en relación con su pesquisa y manejo. Lugar de realización: Institución pública. Población: un paciente de 54 años de edad evaluado y tratado por cáncer de recto y poliposis hiperplásica. Método: presentación de un caso y análisis bibliográfico. Conclusiones: la poliposis hiperplásica es una enfermedad fenotípicamente heterogénica y los individuos afectados tienen riesgo aumentado para desarrollar un cáncer colorrectal.

Background: Hyperplastic polyposis is a sporadic disease, with little known genetic basis that usually present at around 50 years old. It has an increased risk of colorectal cancer up to 50%, according to different series of the literature. With regard to the pathogenesis a sequence of hyperplastic polyposis­serrated adenoma-colorectal cancer has been involved. Objective: To report on a case and to make a literature review on this subject, especially with relation to the screening and management. Place of application: Public Institution. Population: 54 years old patient evaluated and treated for rectal cancer and hyperplastic polyposis. Method: case report and literature review. Conclusions: hyperplastic polyposis is a phenotypicaly heterogeneous disease and affected individuals are at increased risk for colorectal cancer.

Câncer colorretal em pacientes jovens / Colorectal carcinoma in young patients

Introdução: O câncer colorretal costuma ser pouco frequente em indivíduos abaixo dos 50 anos, persistindo ainda controvérsias quanto ao seu comportamento e prognóstico. Objetivo: Avaliar as características epidemiológicas, clínicas, histopatológicas e terapêuticas de pacientes com câncer colorretal, comparando os grupos de faixa etária até 50 anos e idade superior a 50 anos. Método: Trata-se de um estudo descritivo, em que foram analisados prontuários de 505 pacientes com câncer colorretal, atendidos de janeiro de 1998 a dezembro de 2008. Parâmetros clínicos e histopatológicos foram coletados. Resultados: Os indivíduos com idade até 50 anos corresponderam a 26,53 por cento da amostra e não houve predileção por gênero. Alteração no hábito intestinal como queixa inicial e anemia ao exame físico foram significativamente mais comuns no grupo mais jovem. Os pacientes até 50 anos exibiram também estadiamento linfonodal mais avançado, maior ocorrência de carcinoma espinocelular ou neuroendócrino e pior diferenciação histopatológica, bem como maior recorrência local, apesar de maior índice de tratamento cirúrgico e quimioterápico. Conclusão: O câncer colorretal em pacientes com idade até 50 anos mostrou-se mais agressivo e indiferenciado. As queixas, mesmo dos pacientes jovens, devem ser prontamente investigadas, a fim de possibilitar o diagnóstico precoce e maior chance de cura ao paciente com câncer colorretal.